While individuals who have experienced a traumatic spinal cord injury (TSCI) can face a wide range of challenges affecting their health-related quality of life (HRQoL), a new study is helping to clarify that 1 particular functional ability stands out as the most important factor: independent mobility.

Researchers analyzed data from 195 patients who had sustained a TSCI between 2010 and 2016 and participated in a series of assessments conducted between 6 and 12 months after the injury. Those assessments included the Spinal Cord Independence Measure Version 3 (SCIM-III), a detailed assessment of functional abilities, as well as the SF-36v2 assessment of HRQ0L, a 36-question survey covering 8 domains that produces both a physical component score (PCS) and a mental component score (MCS). Authors say their study is the first to establish correlations between these assessments, allowing the researchers to more specifically pinpoint which factors most affect HRQoL.

The study population included individuals 17 years and older who sustained a TSCI between C1 and L1 that required surgery. More than half of the study population—65%—experienced tetraplegia (also referred to as quadriplegia) as a result of the injury; the remaining 35% experienced paraplegia. Participants were excluded if a penetrating trauma was the cause of the TSCI or if they did not complete the assessments between 6 and 12 months after the injury. Results were e-published ahead of print in the American Journal of Physical Medicine & Rehabilitation.

Here's what the researchers found:

Overall, the strongest correlation was between mobility in the abilities assessment and PCS in the HRQoL assessment. Researchers also noted a small-but-significant correlation between respiration/sphincter management and PCS.

The tetraplegic group showed the strongest correlations between mobility and PCS, particularly for mobility outdoors, mobility indoors, mobility for moderate distances, and stair management.

In the paraplegic group, "moderate significant" correlations were also found for lower body bathing.

Researchers were unable to establish a strong correlation between the functional abilities assessment and the mental component score on the HRQoL assessment.

Authors of the study believe their findings line up with previous research into HRQoL among individuals who sustained TSCI, but they note that theirs is the first to examine which specific functional abilities were most important to this population.

"In our study for both tetraplegic and paraplegic patients, mobility on even surfaces was more strongly correlated with PCS than items related to transfers," authors write, adding that "our study suggests that higher mobility is better correlated to quality of life than higher arm/hand function for both tetraplegic and paraplegic subjects."

Authors also note that the lack of correlation between function and the MCS on the HRQoL assessment may seem "counter-intuitive," but they suggest that the findings point to the possibility that "mental health after a TSCI strongly depends on other factors that were not considered in the current study," including depression, hope, purpose, and feelings of self-worth.

"The current study showed that it is of paramount importance to analyze tetraplegic and paraplegic patients distinctly when evaluating impact of function on [quality of life], considering the magnitude of difference between the strength and correlation of SCIM sub-scores," authors write. "Different priorities for patients lead to distinct goals in the rehabilitation effort."

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